Two years ago, I fielded a call from a surgeon I knew of but had not met. Raised locally, she had left the state for undergraduate school, returning to her home state for medical school and staying for her fellowship. Heavily recruited, she wanted to stay close to home and her family, and accepted a position with a group of surgeons practicing at one of the area’s stellar hospitals.
Two years into a three-year employment agreement she was unhappy. In fact, she was angry, frustrated, worried, and greatly concerned about her future.
The genesis of her story is almost a cliché in the problems that frequently crop up after a physician has been recruited by a group. And it’s easy to see where things went wrong. It all involves what I call the “failed entrance strategy.”
This doctor had been pursued by this group, pitching a great future, good salary, moving expenses, and even a signing bonus. Two visits to her soon-to-be employer focused on where to live, meetings with all of the group members, a hospital administrator or two (representing her surgical sites), and a real estate agent to look at homes. Everybody seemed nice and she liked what she had seen.
A contract arrived shortly after the second visit. A lawyer was hired and they focused on the "eight things a medical employment contract must have," taken from a random google search. Her lawyer followed her lead. Within weeks the contract was signed and she returned her focus to her final year, relieved of the pressures of finding a job.
Barely two years later, she was miserable. What could have happened?
From my perspective, the group that hired her didn’t provide her with a complete analysis of what the job entailed, what they were going to do to help her build her practice, how her work would be evaluated, or a host of other things that should have been explored and explained up front.
You can’t expect a new med school grad to come ready with a complete list of operational questions. From my perspective, it’s a requirement that the hiring group provide much more than a “look-see” at the way the practice runs and provides data to its physicians.
Most of her complaints were around issues that should have been discussed and/or documented before any contracts were assembled, much less negotiated.
For example, she never saw examples of the reports provided to each physician that outlined patient counts, charges and revenue. These turned out to be woefully inadequate, and belied some serious issues with the group’s billing practices. The practice had policies and procedures, but they only applied to the staff — there were no rules for the doctors. Governance was not in place. She was assured overflow, but as soon as she arrived everyone got very protective of their patient base and the overflow was far less that what had been promised.